test #42 4.30 Flashcards
gross cirrhotic liver
diffuse hepatic fibrosis w/ regenerative nodules
granulomatous destruction of bile ducts w/ lymphocytic infiltrate
primary biliary cirrhosis
onion-skin bile duct fibrosis
primary sclerosing cholangitis
glossopharyngeal n fxn
- somatic motor: stylopharngeus only
- parasympathetic: otic ganglion: parotid gland
- general sensation:
-inner surface of tympanic membrane
- eustachian tube
- posterior 1/3 of tongue
- tonsilar region
- upper pharynx (afferent gag)
- carotid body
- carotid sinus - visceral sensation:
taste posterior 1/3 of tongue
describe path of parotid gland innervation
inferior salivatory nucleus CN IX otic ganglion travel along auriculotemporal n (CN V) parotid gland
salivation from submandibular & sublingual gland from? parotid?
submandibular & sublingual
FACIAL
- superior salivatory nucleus, CN VII (facial) via chorda tympani n (lingual n) across submandibular ganglion
parotid:
GLOSSOPHARYNGEAL
- inferior salivaatory nucleus, CN IX (glossopharyngeal), otic ganglion, travel w/ auricotemporal n CN V
think: facial n travels THOUGH parotid, but doesn’t innervate it!
M3 AML chromosomal translocation
t(15,17)
peroxidase +
M2 AML chromosomal translocation
AML w/ maturation
Aur rods present, peroxidase +
t (8,21)
molecular defect in CLL
deletion of 13q
FSH, LH, estradiol in pt w/ severe anorexia
ALL down. inadequate hypothalamic-pituitary gonadotropic secretion
distal ileum winding around a thin vascular stalk
think appel peel atresia
causes of jejunal, ileal, colonic atresia
NOT abnormal fetal development / malformations.
result from VASCULAR ACCIDENTS in utero
describe jejunal, ileas, colonic atresia process
vascular occlusion, diminished intestinal perfusion leads to ischemia of a segment of bowel.
subsequent narrowing / obliteration of lumen.
ileum most often affected
if SMA affect –> intestinal wall necrosis forms blind-ending proximal jejunum. terminal ileum distal to atresia forms a spiral configuration around an ileocolic vessel – “apple peel’ or ‘christmas tree’ deformity
mechanism of duodenal atresia
failure of recanalization
for jejunal, ileal, colon –> vascular accident
what favors non-renal clearance (hepatic metabolism / clearance)
high lipophilicity & high volume of distribution
lipophilic – lets it enter hepatocyte
– poorly eliminated in kidney as they rapidly cross tubular cell membranes after filtration
primary site of drug excretion
kidney
primary site of drug biotransformation / metabolism
liver (also does some excretion in bile)
calcium chelator that prevents stone formation
citrate
ulcer on lesser curvature of stomach can penetrate what artery
left gastric
ulcer on duodenum can penetrate what artery
gastroduodenal
where do gastric ulcers most commonly form
lesser curvature of stomach
transitional zone between acid-secreting epitheium of corpus & gastrin-producing epithlium of antrum
measure of fetal lung maturity
lecithin/sphingomyelin ratio
(L/S ratio)
phosphatidylcholine / sphingomyelin ratio
1/1 until 3rd trimeter.
week 25 ~ 2:1 ratio
phosphatidylcholine is also know as
lecithin
how do tyramine foods trigger hypertensive crisis w/ MAOi?
tyramine is a sympathomimetic, usu metabolized in GI tract.
MAO inhibitors block degradation, allow it to flow in circulation
phenelzine
MAOi
tyramine containing foods
cheese, sausage, wine
trancypromine
MAOi
isocarboxazid
MAOi
paroxetine
SSRI
chlomipramine
TCA
depressed patient who has hypertensive crisis after cheese or wine
MAOi
agent in pneumonia in HIV+ w/ T-cell >800
still s. pneumonia; he is immunocompetent
when are HIV+ patients at risk for TB
anytime, regardless of CD4+ count
streptokinase
converts plasminogen –> plasmin. dissolves thrombi
also destroy: fibrinogen, factor V and VII
major side effect: hemorrhage
where is streptokinase derived from
beta-hemolytic bacteria! can cause HSR
diarrhea caught from a pet puppy?
campylobacter
domestic animal –> human
characterestic motility of campylobacter. growth?
“corkscrew” fashion
grows at 42 degress!
most common cause of acute gastroenteritis in children & adults in industrialized country?
camplyobacter jejuni
- domestic animals
- contaminated food (undercooked chicken, unpasteurized milk)
diarrhea w/ campylobacter?
inflammatory: initially watery, then bloody
infectious agent most associated w/ guillan-barre?
camplyobacter jejuni
shock w/ hyponatremia, hyperkalemia, and hypoglycemia suggests..
adrenal crisis
fever, vomiting, nuchal rigidity, and petechial rash suggests
meningococcal menigitis
Neisseria meningitis septicemia can result in..
Waterhouse-Fridrichsen syndrome; adrenal hemorrhage –> acute adrenal crisis
waterhouse-friedrichsen
adrenal hemorrhage w/ neisseria septicemia
PKA is stimulated by what upstream agent
G protein coupled receptor!
4 types of nonneoplastic polyps
- hyperplastic: well-differentiated mucosal cells, form glands & crypts
- hamartomatous: mucosal glands, smooth muscle, connective tissue.
can occur sporadically via Peutz-Jeghers or juvenile polyposis
- inflammatory: regenerating intestinal mucosa (ulcerative colitis or crohn’s)
- lymphoid: in children. instestinal mucosa infiltrate w/ lymphocytes
juvenille polyps are often..
hamartomas
most common nonneoplastic polyp
hyperplastic.
(>50% in rectosigmoid)
serrated “saw tooth”
well differentiated musocal cells, form glands & crypts
determinants of adenomatous polyp malignant potential
- degree of dysplasia
- histologic pattern: VILLOUS more likely than tubular to transform
- size of adenoma >4cm have 40% chance of malignancy
human mitochondrial DNA codes for..
37 genes for 13 proteins, 2 rRNA, 22 tRNA
produce some proteins needed for oxidative metabolic pathways
(nuclear DNA encodes for MOST proteins in mitochondria)
genetic code in mitochondria vs. nucleus
slightly different.
vitamin precursor to NAD+
tryptophan
what type of diet predisposes to pellagra?
corn-based!
niacin in corn is unabsorbable
pellagra can present in what type pt
corn-based diet
hartnup disease
carcinoid
alcoholic
carotene is the precursor to..
vitamin A
arginine is precursor to..
nitric oxide, urea, ornithine, agmatine, creatinine
nonsense, missense all result from
single base SUBSTITUTION
insertion/deletion –> FRAMESHIFT
optic neuritis, intention tremor, pain w/ ocular movements suggest
waxing & waning neuro deficits in 20-30 y/o
multiple sclerosis
SIIIN
- scanning speech
- intention tremor
- incontinence
- internuclear opthalmoplegia
- nystagmus
usu present w/ optic neuritis
CSF in multiple sclerosis
elevated IgG
- oligoclonal band on electrophoresis
suggests activation of B cells
in what population is multiple sclerosis more common
temperate latitudes, USA, Canada, Northern Europe
periventricular plaques on MRI
think multiple sclerosis
rx: for MS
- beta-interferon
- natalizumab (ab against alpha 4 integrin, blocks migration of inflammatory cells across BBB)
- baclofen - GABAb antagonist for spasticity
metyrapone testing
inhibits 11-b-hydroxylase. can’t convert 11-beta-deoxycortisol into cortisol
REDUCE serum cortisol, which should stimulate ACTH release, which builds up deoxycortisol (metabolite in urine -> 17-hydroxycorticosteroid)
unlike cortisol, deoxycortisol does not inhibit ACTH release.
normal HPA axis: increase 11-deoxycortisol in serum. increase 17-hydroxycorticosteroid in urine.
test for normal ACTH secrection (HPA-adrenal axis)
metyrapone testing
reduce serum cortisol,
expect elevated ACTH,
will generate elevated 11-deoxycortisol in serum & 17-hydroxycortisol in urine
bc metyapone blocks 11-b-hydroxylase
before prescribing isotretinoin (accutane) for acne, what must be checked
pregnancy test!
serum b-HCG
how does isotretinoin reduce acne
inhibits follicular epidermal keratinization, loosening keratin plugs of comedones, facilitating their expulsion.
reduces size of sebaceous glands and inhibits sebum production.
TERATOGEN & HYPERTRIGLYCERIDEMIA
fate of duodenal ulcer on anterior wall? posterior wall?
anterior wall: perforate
posterior wall: hemorrhage (gastroduodenal artery)
what is the duodenal bulb
begins at pylorus, ends at neck of gallbladder, and rests posterior to gallbladder & liver.
head of pancreas located inferiorly
major toxicity of thiazolidinediones
hepatoxoticity, must monitor LFTs
thazolidinediones can be used for..
metabolic syndrome, nonalcoholic fatty liver disease (NASH), PCOS
(insulin resistance)
for what drugs must thyroid function tests be monitored
amiodarone and lithium
what diabetes drugs cannot be used w/ renal problems?
metformin! the risk of lactic acidosis increases w/ renal failure
side effects of thiazolidinediones (2)
hepatotoxicity
fluid retention, which can exacerbate CHF if have underlying cardiac problems.
niacin side effects
- hyperuricemia
- hyperglycemia (insulin resistance –> acanthosis nigricans)
- flushing (vasodilation)
rx for essential tremor
propanolol
inheritance of essential tremor
autosomal dominant
tremor when holding posture
essential tremor
resting tremor
parkinsons
charcoal yeast extract agar supplemented w/ cysteine
Legionella
subthalamic nucleus
major excitatory input to GPi, when then strongly inhibits thalamus
direct path in basal ganglia
putamen -> GPi -> thalamus
indirect path in basal ganglia
putamen -> GPe -> subthalamic nuclei -> Gpi -> thalamus
damage to subthalamic nucleus results in..
contralateral hemiballiusmus
no longer stimulating GPi to inhibit thalamocortical circuit. now: thalamocortical circuit too active
clinical presentation of wilson’d disease basal ganglia degeneration
wing-beating tremor, psychosis, cirrhosis
dejerine-roussy syndrome
central post-stroke pain syndrome, after thalamic stroke
have numbness, tingling, burning, stabbing pain on one half of body, contralateral to thalamic stroke
Meniere’s disease
increased volume of endolymph in inner ear (due to decreased resoption)
distention damages both vestibular and cochlear components of inner ear
triad:
- tinnitus
- vertigo
- hearing loss
distinguishing vertigo from meniere’s disease vs. schwanoma in cerebellopontine angle
same triad:
- tinnitus
- vertigo
- hearing loss
meniere: wax & wane. episodic
schwanomma of CN VIII: progressive and constant
vertigo vs. diziness
vertigo: sensation of motion in absence of actual motion
dizziness: sensation of lightheadedness
central vs. peripheral vertigo
peripheral: meniere, semicircular canal debris, etc
- >positional testing, delayed horizontal nystagmus
central: i.e. stroke of vestibular nuclei, posterior fossa
- >positional testing, immediate nystagmus in any direction, may change directions.
airway flow rate is directly related to? inversely related to?
directly related to pressure difference in alveoli & mouth
inversely related to airway resistance
describe airway resistance
like vessels, airway resistance inversely related to cross-sectional area of conductive vessel.
describe why pulmonary fibrosis has increased FEV1 (expiratory flow rate)
decreased lung compliance (increased elastic recoil & increased radial traction (interstitial fibrosis) –> less airway resistance, increased expiratory flow rate
describe why emphysema/COPD has reduced FEV1 (expiratory flow rate)
airways narrowed / loss of radial traction on airways–> increased airway resistance, so reduced expiratory flow rate.
CEA is produced by..
70% of colorectal & pancreatic cancer
CA 19-9 is produced by
pancreatic cancer
AFP is related to which cancer
hepatocellular cacinoma
nonseminomatous testicular germ cell cancer (i.e. yolk sac)
CA-125
secreted by malignant ovarian epithelial tumors
90% with advanced ovarian carcinoma have it. 50% w/ early stage.
b-HCG is produced with which pathology
hydatidiform mole
choriocarcinoma
gestational trophoblastic tumor
Ca-15-3 / CA-27-29
breast cancer
RET gene
membrane bound tyrosine kinase receptor
mutated in 95% of familial medullary thyroid cancer & many sporadic too
activating mutation in proto-oncogene
RAS mutations are common in..
AMP kinase pathway – cell prolif
follicular thyroid cancer, follicular adenoma
anaplastic thyroid carcinoma often have..
inactivating p53 mutations
Curling ulcers
ulcers in proximal duodenum in associated w/ severe trauma or burn
Cushing ulcer
ulcer in esophagus, stomach, or duodenum in patients w/ high intracranial pressure
direct stimulation of vagus nerve, hypersecretion of acid
chronic gastritis w/ antral sparing
autoimmune, type A
chronic antral predominant gastritis
h. pylori
intestinal subtype of gastric adenocarcinoma
intestinal: arises from precursor lesion
intestinal glands similar in appearance to those of colonic adenocarcinoma
diffuse subtype of gastric adenocarcinoma
characterized by signet ring cells
epiphyseal cartilage is also known as..
growth plate
diaphysis, metaphysis, epiphyseal cartilage, epiphysis
short stature in growth hormone / IGF-1 deficiency
will be proportional, in both axial and appendicular skeleton
unlike achondroplasia, where normal axial length, short appendicular limbs
most common location for anal fissure
posterior midline (poorly perfused), distal to dentate line.
severe tearing pain w/ passage of bowel movement.
may see skin tag.
associate w/ low fiber diet
mannitol primary affects (2) of renal tubules
- PCT
2. descending loop of henle
spironolactone good for heart failure?
diuretic, and also prevents aldosterone induced cardiac remodeling
ethacrynic acid
loop diuretic
bumetanide
loop diuretic
how much cardiac output does the brain receive?
15%
consumes 20% of all O2 in body
when does PCO2 cause cerebral dilation? when does PO2?
PCO2 – linear change!
PO2 – only kicks in <50mmHg (very low)
why must supplemental oxygen be used carefully in COPD patients?
chronic hypercapnia causes oxygen to be primary mediator of respiratory drive.
O2 supplementation can lead to respiratory suppression & coma
team physician’s responsibility
overriding duty of all physicians is to protect health & safety of patient.
preferences expressed by patient cannot influence decision
student athletes sign authorization form permitting physician to SHARE health info w/ coaches (family educational rights & privacy act)
employed by university, not the personal physician. exception to HIPAA.
acute onset heart failure after recent viral infxn..
think dilated cardiomyopathy caused by viral myocarditis
dilated cardiomyopathy excludes what causes
dilation due to..
coronary artery disease, valvular pathology, congenital disorders
typically a diagnosis of exclusion
progressive pathophysiology of dilated cardiomyopathy
- initial ventricle dilation and dysfunction w/ progressive biventricular myocardial failure
- reduced stroke volume –> increased ventricular end-systolic and end-diastolic volumes
- ventricular dilation –> regurgitation across AV valves
progression of primary biliary cirrhosis
- precirrhotic:
intralobular bile ducts destroyed by granulomatous inflammation “florid duct lesions”
&
heavy portal tract infiltrate of macrophages, lymphocytes, plasma cells, eosinophils
(like graft vs. host disease!)
- eventually progressive hepatic damage due to obstructed intrahepatic bile flow.
liver -> green and micronodular
graft vs. host disease histologically mirrors what liver pathology
primary billiary cirrhosis
granulomatous lesions of intralobular bile ducts.
heavy portal tract infiltration of macrophage, lymphocyte, plasma cells, and eosinophils.
liver in budd-chiari
thrombosis of hepatic vein
hepatomegaly, abdominal pain, ascites
liver: swollen, reddish purple, tense capsule
liver in acetominophen toxicit
centrilobular necrosis, that can extend to include entire lobule
deficiency in crigler-Najjar
autosomal recessive
absent UGT
uridine diphosphate glucuronyltransferase in endoplasmic reticulum
present as baby w/ persistent jaundice, muscle rigidity, lethargy, seizure
fate of excess conjugated bilirubin
water soluble, bound to albumin, can be excreted in urine
fate of excess unconjugated bilirubin
insoluble in water! deposits in tissue, including brain
leads to kernicterus–> bilirubin encephalopathy
dubin johnson deficiency
autosomal recessive
absence of biliary transport protein MRP2 – hepatocellular excretion of bilirubin glucoronides into bile canaliculu
dark liver
rotor syndrome deficiency
rare autosomal
asymptomatic conjugated hyperbilirubinemia.
numerous defects in hepatic uptake & excretion of bilirubin pigments
no black liver
bile acid deconjugation
removal of glycine and taurine, rendering less soluble, impairing reabsorption of bile acid and fat absorption
done by anareobes
CD19+ CD20+
precursor B cell
CD1+ CD2+ CD5+
precursor T cell
describe lymphoblast
immature, high nuclear-to-cytoplasmic ratio, variably condensed nuclear chromatin, prominent nucleoli
B-ALL presentation
Tdt+, CD19+, CD20+
bone marrow failure; thrombocytopenia and/or anemia and/or neutropenia
usu young child
presentation of T-ALL
usu teen, adolescent
high leukocyte count, large mediastinal mass.
TdT+, CD1a, CD3, CD4, CD5, CD8
cell markers of CLL/SLL
mature B cell lymphoma
CD19+ B cell marker
CD5+ T cell marker
neoplasm of small, round, monomorphic B-lymphocytes in peripheral blood, bone marrow, and lymph nodes.
CD19+ CD5+
B cell, T cell marker respectively
CLL/SLL, mature B cell leukemia
how to distinguish precursor B-ALL and precursor T-ALL
only w/ immunophenotyping for CD status
TdT+
marker for pre-B cell and pre-Tcell
